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PubMed1994

[Complicated cataract after vitrectomy and gas-liquid exchange].

Cases with complicated cataract occurring after vitrectomy and gas-liquid exchange were reported. In a consecutive series of 62 eyes having undertaken the operation, a transient cataract developed in 8 eyes and an irreversible cataract in 28 eyes. The manifestation of the transient cataract is the posterior subcapsular opacity, feathery or placoid vacuolar in clusters in appearance. It was found that if the amount of the residual vitreous at the retrolental space is great enough, the chance of occurrence of complicated cataract is less. That the direct contact of the gas with the lens affects the lens metabolism and nutrition is the chief cause of the development of the cataract. It is suggested that to prevent the development of cataract induced by the gas, besides selection of body posture, quiet stay in bed and proper selection of gas type, the vitreous at retrolental space be resected as little as possible.

Adolescent↗

PubMed1994

[Personal experience with expanding gases in pars plana vitrectomy].

At the Second Ophthalmological Clinic in Prague the authors operated between January 1991 and November 1993 50 patients, 33 men and 17 women. The mean age of the patients was 43.6 years, the minimum observation period 5 months. In all patients pars plana vitrectomy was performed (PPV) and at the end of the operation or subsequently into the vitreous space the expansive gas SF6 (hexafluorosulphide) or C3F8 (perfluoropropane) was insufflated. In all instances the authors indicated the expansive gas for treatment or prevention of retinal detachment and with regard to this they divided the patients into two groups: 1. From the total number of 50 patients the authors operated in the first group 31 patients with complicated retinal detachment (RD). In 17 patient RD with large postequatorial tears and traces of blood in the vitreous space were involved. In 7 patients the cause of RD was a severe eye injury. In five patients the authors found a macular opening, in one patient a large postequatorial tear in the temporal half and in one patient a circumscribed tractional RD associated with diabetic proliferative retinopathy was involved. 2. In the second group of 19 patients the gas was used as prevention of RD. In 5 patients after transvitreal extraction of a foreign intraocular body with suspected or obvious retinal defect. In two patients after extraction of a posterior lenticular luxation following severe contusion of the eye. In the remaining 12 patients the expansive gas was used after removal of silicone oil (SO) and the gas was used at the same time to prevent hypotonia of the eye. Anatomical results of surgery. 1. In the group of 31 patients with complicated RD after PPV and gas insufflation the retina adhered anatomically in 23 patients (74%). In the group with PVR C1-C3 in 13 patients after gas insufflation the retina became attached in 10 patients (76.9%). In one of these patients after three months accentuated cerclage was performed because of a new fissure. 2. In the group of 19 patients where gas was used for preventive reasons the retina became detached only after removal of SO in 5 of 12 patients (42%). Functional results of operation. To assess final vision the authors evaluated in the first group a total of 39 patients only after gas insufflation and in the second group another 11 patients after reoperation with implantation of SO.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1994

[Treatment of macular hole retinal detachment with vitrectomy].

Pars plana vitrectomies were performed on 64 eyes with macular hole retinal detachment of which 20 with severe proliferative vitreoretinopathy (PVR C-D) and 18 with definite vitreoretinal traction on the maculae were found. Retinal reattachment occurred in 57 eyes in the follow-up (89.1%) of which the visual acuities improved in 43 (74.5%), unchanged in 13 and decreased in 1. The points for attention in the operation were discussed. The key factors influencing the success of the operation are severe PVR, the course of the retinal detachment.

Adult↗

PubMed1994

Vitrectomy for pars plana placement of a glaucoma seton.

Trabeculectomy, even with supplemental antifibrosis agents, has a low success rate in controlling intraocular pressure (IOP) in certain cases; ones involving severe anterior-chamber-angle disease are particularly challenging. Ten patients with advanced, non-neovascular glaucoma underwent vitrectomy and pars plana placement of seton implants. The tube was placed through the pars plana sclerotomy in each case because severe anterior chamber angle narrowing, aphakia, or penetrating keratoplasty prevented standard placement. Previous trabeculectomy had failed to control IOP in 9 of the 10 patients. In each, the preoperative IOP was 25 mm Hg or more despite maximal medical therapy. In nine of the patients, the postoperative IOP was 19 mm Hg or less, without pressure-lowering agents. The seton appeared to be functional in all of the cases. Vision remained stable or improved in seven cases, but deteriorated in three due to graft failure, progressive traction retinal detachment, or rhegmatogenous retinal detachment (one case each). Pars plana placement of tubes for glaucoma seton implants should be considered as an alternative to anterior chamber placement in certain cases of refractory glaucoma in which the anterior chamber anatomy has been severely disrupted.

Adult↗

PubMed1993

Perfluoropropane 12% versus 20%. Effect on intraocular pressure and gas tamponade after pars plana vitrectomy.

A randomized prospective study was performed on 30 nonglaucomatous eyes undergoing pars plana vitrectomy and intraoperative fluid-gas exchange, comparing the effect of two perfluoropropane gas concentrations (12% and 20%) on postoperative intraocular pressure, early postoperative bubble size, and intravitreal longevity. No significant differences in mean intraocular bubble size at 36 to 48 hours and mean peak and final follow-up intraocular pressure were found between the 12% group (n = 15) and the 20% group (n = 15, unpaired T-test). Intravitreal longevity was significantly greater for the 20% concentration (mean +/- standard deviation = 8.4 +/- 1.8 weeks) compared with the 12% concentration (mean +/- standard deviation = 6.7 +/- 1.6 weeks). In nonglaucomatous eyes under careful observation and appropriate antiglaucoma therapy, the choice between a 12% or 20% concentration of perfluoropropane gas determined primarily longevity of gas tamponade rather than postoperative pressure or early bubble size.

Double-Blind Method↗

PubMed1993

Transient disappearance of a symptomatic macular hyperfluorescent lesion following vitrectomy: a case report.

We have presented a case of symptomatic macular fluorescence of a presumed vascular etiology that transiently disappeared post vitrectomy. Laser photocoagulation to the involved area resulted in a good visual outcome. We propose that the transient improvement in the fluorescein leakage represented a temporary alteration of cellular metabolism, or vascular perfusion, attributable to the perfusion solution. We suggest that additional studies are indicated to further explore this phenomenon and its potential clinical applicability.

Fluorescein Angiography↗

PubMed1993

[Use of perfluorodecalin during vitrectomy in diabetics].

Thirty eyes in 27 patients were operated for complications of proliferative diabetic retinopathy using a perfluorocarbon liquid, highly purified perfluorodecalin; 3 patients were lost to follow-up leaving 27 eyes for evaluation. Fourteen eyes presented traction-rhegmatogenous retinal detachment; 10 eyes underwent vitrectomy for traction retinal detachment and 3 eyes for progressive fibrovascular proliferation: in these 13 eyes, dissection of fibrovascular proliferation was complicated by iatrogenic holes with surrounding retinal detachment. The intraoperative use of perfluorodecalin facilitated flattening of the retina and endophotocoagulation. Perfluorodecalin was removed at the end of the procedure, and intraocular tamponade was provided by silicone oil in 12 cases, and by gas in 15 eyes. Anatomical success was obtained in 21/27 cases with a minimum of 6 months and a maximum of 25 months of follow-up (mean follow-up: 10.9 months). Complications from the intraoperative use of perfluorodecalin were observed in two cases: one patient had residual droplets of perfluorodecalin, which were removed during a reoperation; in another patient, small subretinal droplets of perfluorodecalin were observed postoperatively without apparent toxicity after 22 months of follow-up. Eleven eyes had improved vision, 8 eyes had the same vision, and 8 eyes had decreased vision. The main advantage of intraoperative use of perfluorodecalin was to allow easy flattening of the retina and effective endophotocoagulation under optimal visual conditions.

Adult↗

PubMed1994

Restoration of intraocular pressure after streptococcus endophthalmitis with vitrectomy.

A bleb infection and subsequent endophthalmitis developed in the left eye of a 68-year-old man who had had a trabeculectomy. Vitreous injections of vancomycin and gentamicin were given, and vitreous cultures grew alpha-Streptococcus. Postoperatively, as the intraocular inflammation resolved, intraocular pressure (IOP) markedly decreased secondary, in our judgment, to ciliary body ischemia. A pars plana vitrectomy relieved the tractional bands and restored the IOP.

Aged↗

PubMed1994

Retinal hemodynamics after pars plana vitrectomy with silicone oil tamponade.

Pars plana vitrectomy with silicone-oil tamponade is frequently performed in cases of complicated retinal detachment. Because of the lower specific gravity and the lower surface tension of silicone oil in comparison with the aqueous phase of the vitreous, an influence on the blood flow in the retinal vessels would be expected. However, not only the silicone oil but also the operative trauma and a buckling procedure may have an influence on the retinal blood flow. To examine this question we measured the arteriovenous passage time in the silicone-oil-filled eye and in the contralateral eye in 14 cases using a laser scan ophthalmoscope at 3-5 days after surgery. The arteriovenous passage time is a parameter for the retinal microicirculation. In all cases we found a prolonged arteriovenous passage time in the silicone-oil-filled eye in comparison with the contralateral eye (mean value +/- SD, 2.5 +/- 0.8 vs 1.25 +/- 0.25 s; P < 0.01). The prolongation of arteriovenous passage times observed in silicone-oil-filled eyes indicates that the microcirculation is worsened at least during the early postoperative period.

Adult↗

PubMed1993

Pars plana vitrectomy for complications of retinal arterial macroaneurysms--a case series.

Retinal arterial macroaneurysms are distinct vascular lesions with a typically benign course. Laser treatment to these vascular lesions is controversial, and has been limited to cases of persistent macular edema. Devastating vision loss can occur, however, through vitreous or subretinal hemorrhage. We describe eight cases of retinal arterial macroaneurysms associated with subretinal or vitreous hemorrhage requiring pars plana vitrectomy. Final visual acuities ranged from 20/20 to 20/400 at most recent follow up. Until reliable indicators of rupture are identified, we suggest consideration of laser photocoagulation to clinically active, identifiable retinal arterial macroaneurysms within the macula.

Adult↗

PubMed1993

Endolaser photocoagulation after vitrectomy on rabbit's eyes.

Ophthalmoscopic and histopathologic studies of endolaser photocoagulation after vitrectomy were carried out on rabbit's eyes. The endoprobe was connected to the Coherent "Novus 2,000" argon laser system. Under appropriate application the grayish white retinal lesions produced by argon green and argon all wavelength endolaser photocoagulation were similar ophthalmoscopically at a treatment power of 80-100 mw and exposure duration of 0.2s. Histopathologically, the characteristic changes of the retinal lesions produced by argon all wave-length were more significant than that produced by argon green endolaser photocoagulation. Scattered retinal photocoagulation can be done when the opaque medium is cleared on the operating table.

Animals↗

PubMedDate not supplied

[The surgical causes for the development of retinal detachment in experimental vitrectomy].

The operative causes of development of detachment of the retina after vitrectomy were experimentally studied. The principal causes were scleral incision outside the flat segment of the ciliary body, ciliary body injury, traction exposures, intraocular pressure differences. Specific features of the morphologic picture were detected related to exposure to a certain aggravating factor.

Animals↗

PubMed1993

[Effect of intraocular irrigating solution on electroretinogram during pars plana vitrectomy].

The effects of intraocular irrigating solutions on the human retina are not known. We recorded 30 Hz-flicker electroretinograms (ERGs) during vitrectomy, and examined the effects of perfusate S-MA2 and DE-057 on the human ERG. The amplitude of the 30 Hz-flicker ERGs were not significantly different for the two irrigating solutions. The peak latency of the 30 Hz-flicker ERG was increased 14 +/- 4.4% (mean +/- SE) during irrigation with S-MA2, compared with the preoperative peak latency. Replacement of S-MA2 by DE-057 increased the peak latency by 37 +/- 5.8% (p < 0.01). Since the peak latency of the 30 Hz-flicker ERG became shorter after replacement of DE-057 by S-MA2, these effects were reversible (p < 0.01).

Aged↗

PubMed1993

[Pars plana vitrectomy in epimacular membranes].

Epimacular membranes /EMM/ reduce markedly visual acuity and the only treatment is pars plana vitrectomy /PPV/ and removal of the EMM. The authors analyzed the results of PPV in 30 eyes with EMM of different aetiology. The group comprised 4 idiopathic EMM and 26 secondary EMM after operations of a detached retina, injury, intraocular inflammation, occlusion of the retinal vein and retinopathies of the premature. The operation markedly improved the visual acuity in 20 eyes /67%/ and the best results were obtained in idiopathic EMM. The prognosis did not depend on the preoperative visual acuity and duration of the disease and was determined by the state of the macula beneath EMM which in dense secondary EMM is difficult to assess before operation. The poorest functional results were obtained in postinflammatory and post-traumatic EMM.

Adolescent↗

PubMed1993

Vitrectomy and fluid/silicone oil exchange for giant retinal tears: 10-year follow-up.

A total of 39 eyes of 39 patients, previously reviewed 5 years after vitrectomy and fluid/silicone oil exchange for giant retinal tears, were reexamined after 10 years. The retina remained attached in 30 eyes (77%), and in no case had redetachment occurred in the interval between 5 and 10 years after surgery. In all, 3 groups of eyes were identified, 20 eyes with attached retinas and visual acuities of 6/60 or better (group I), 10 with attached retinas and vision of less than 6/60 (group II) and 9 in which the retina was detached (group III). Eyes in group I were found to be stable, with future improvement anticipated in some cases with cataracts. A majority of group II eyes were deteriorating due to glaucoma and keratopathy. Failure in group III was due to proliferative vitreoretinopathy in all except one instance. Measures aimed at reducing the incidence of epiretinal membrane proliferation, glaucoma and keratopathy are recommended to improve long-term results in the treatment of retinal detachments complicated by giant retinal tears. These include the use of safer methods of retinopexy, preservation of the lens when possible, early removal of silicone oil and a reduction in the use of scleral buckles.

Adolescent↗

PubMed1996

Vitrectomy and juvenile epiretinal membrane.

The cases of two children who had idiopathic epiretinal membranes are reported. Causes for juvenile epiretinal membranes, including trauma, pars planitis, toxocariasis, Coats' disease, or combined hamartomas, were not present. Both patients previously had documented normal vision in the affected eye. Observation revealed deterioration of vision, and a pars plana vitrectomy and a membranectomy were performed. The 5-year -old girl's vision improved from counting fingers at 5 feet to 20/80. The 12-year-old boy's vision improved from 20/200 to 20/80. Selected cases of juvenile epiretinal membranes may benefit from surgical excision.

Child↗

PubMed1996

[Responsibility of incomplete retinal photocoagulation in the indication of vitrectomy in proliferative diabetic retinopathy].

PURPOSE: We report an epidemiologic study about prophylactic photocoagulation of ischaemic diabetic retinopathy in order to avoid proliferative stage and severe vitreous haemorraghe. METHODS: We studied retrospectively 42 eyes of 32 diabetic patients who underwent a vitrectomy in 1993. For each patient several items were analyzed: nationality, sex, age, type, duration and clinical course of diabetes, and other risk factors. Slit lamp and ocular fundus examination were noted; in particular lens, iris and vitreoretinal framework. RESULTS: Almost all patients had an inadequate laser photocoagulation: in 26 eyes (62%) it was insufficient or non-existent, uncomplete in 12 eyes (29%), and non confluent for 18 eyes (43%). Only four eyes have had complete and confluent panphotocoagulation. CONCLUSION: Photocoagulation appears to be the priority therapy to avoid most severe complications of proliferative diabetic retinopathy. Laser photocoagulation must be started from preproliferative retinopathy, confluent on the useless ischaemic retinal areas, and dense elsewhere.

Adult↗

PubMed1995

[A comparison of attachment rates between SF6 and silicone oil tamponades following vitrectomy for treatment of complicated retinal detachment].

In this study, 215 eyes with rhegmatogenous retinal detachment and proliferative vitreoretinopathy (PVR) including giant tears, macular holes, perforating injury and traction caused by retinal vascular diseases were treated by vitrectomy and SF6 or silicone oil. The anatomic attachment rates were compared between gas and silicone oil groups in non-vitrectomized eyes and previously vitrectomized eyes, respectively. Both gas and silicone oil groups showed higher attachment rates in stage C of PVR, giant tears with PVR less than stage C2 and macular holes. The gas group showed lower attachment rates in cases with stage D of PVR, giant tear larger than 180 degrees or with PVR C3 or greater than C3, after perforating injury and traction-rhegmatogenous retinal detachment, while silicone oil group showed better attachment rates. The choice of tamponades should be based on different indications.

Adolescent↗